Provider Demographics
NPI:1962477992
Name:ORANGE CITY MUNICIPAL HOSPITAL
Entity Type:Organization
Organization Name:ORANGE CITY MUNICIPAL HOSPITAL
Other - Org Name:ORANGE CITY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:GUTHMILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-737-5274
Mailing Address - Street 1:1000 LINCOLN CIR SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORANGE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51041-1862
Mailing Address - Country:US
Mailing Address - Phone:712-737-2000
Mailing Address - Fax:712-737-2115
Practice Address - Street 1:1000 LINCOLN CIR SE
Practice Address - Street 2:SUITE 100
Practice Address - City:ORANGE CITY
Practice Address - State:IA
Practice Address - Zip Code:51041-1864
Practice Address - Country:US
Practice Address - Phone:712-737-2000
Practice Address - Fax:712-737-2115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA24914OtherBLUE CROSS/BLUE SHIEL
IA0249144Medicaid
IA24914OtherBLUE CROSS/BLUE SHIEL
IA0249144Medicaid
IA161360Medicare Oscar/Certification
IA=========001OtherTRICARE